Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 016-002682 | IL |
NPI | 1427148774 |
---|---|
Provider Name | Dr. Robert Stephen Ardell |
First Address | Chicago, IL 60602-1903 |
Second Address | Chicago, IL 60602-1903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 04/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T36909 | (02) | IL |